Skin and Cosmetics

Skin in pregnancy: less is more

Pregnancy takes several skincare options off the table at once: every vitamin A derivative, most high strength peels and most energy based procedures such as radiofrequency, mesotherapy and elective laser work are paused for about 40 weeks, mainly because no controlled trials have tested them in pregnant women rather than because harm has been proven. Meanwhile, hormone driven pigmentation called melasma shows up in 50 to 70 percent of pregnancies, so a broad-spectrum mineral sunscreen of SPF 30 or higher becomes the single most useful step, alongside gentle, fragrance-free cleansing and a plain moisturiser on stretching skin.

What changes once you are pregnant

Hormones move skin in several directions at once, and pigmentation is the most visible sign of it. Up to 90 percent of pregnant women show some increase in pigmentation, most obviously as a dark line down the middle of the abdomen, darker nipples and, in 50 to 70 percent of pregnancies depending on the population studied, symmetrical brown patches on the cheeks, forehead and upper lip known as melasma or the mask of pregnancy.

The second big change is stretching. Skin over the abdomen, breasts and thighs grows faster than its connective tissue can adapt, and stretch marks appear in 63 to 90 percent of pregnancies, most often during months 6 and 7. Smaller vascular changes are common too: around 67 percent of pregnant women develop fine dilated blood vessels called telangiectasia, mostly between months 2 and 5, and about 62 percent notice a change in at least 1 or 2 nails, such as brittleness or ridging. None of this is dangerous; it is hormones and mechanical stretch acting on skin at the same time.

What comes off the list, and why

Every vitamin A derivative comes off the shelf for the whole pregnancy and while breastfeeding: retinol, retinaldehyde, tretinoin, adapalene, tazarotene and oral isotretinoin all fall into this group. Oral isotretinoin is clearly teratogenic even at low doses. Topical tretinoin absorbs far less and clears the body within about 1 day on average, but case reports describing a similar pattern of birth defects to the oral form are reason enough for dermatology guidance to recommend stopping topical retinoids roughly 1 month before trying to conceive, and staying off them throughout.

The reasoning goes beyond retinoids. A background risk of a birth defect, about 3 in 100 pregnancies, exists with no skincare exposure at all, so anything with a theoretical risk and no real benefit gets removed rather than argued over. Chemical peels follow the same rule: a glycolic acid peel at up to 10 percent, with a pH above 3.5, is considered low risk, while anything stronger, or salicylic acid used broadly, at a high concentration or under a dressing, is not. Hydroquinone, usually applied at 2 to 4 percent for pigmentation, is paused for the same reason: not enough safety data, not a proven danger.

Energy based procedures pause as a category rather than case by case. Radiofrequency, mesotherapy and elective laser or IPL sessions share the same gap: no controlled trials have tested them in pregnant women. Most clinics reschedule these appointments for after delivery or after breastfeeding instead of treating during pregnancy without a medical reason to proceed sooner.

What actually earns a place in the routine

Sun protection moves to the top of the list, because melasma reacts to UV rays and to visible light, unlike an ordinary sun spot. A broad-spectrum mineral sunscreen, SPF 30 or higher, reapplied roughly every 2 hours outdoors, is the daily baseline through all 40 weeks of pregnancy; a tinted formula with iron oxide adds the visible-light protection that a plain UV filter misses.

For pigmentation and mild acne together, azelaic acid is the main substitute for the ingredients on the pause list, with only 3 to 8 percent of the applied dose absorbed into the bloodstream. Cleansing turns milder too: a fragrance-free, low-foam cleanser replaces stronger exfoliants, since pregnancy skin tends to react more easily than before.

On the abdomen, breasts and thighs, a plain moisturiser or oil used daily keeps stretching skin supple and eases the itching that comes with fast growth, even though it will not reliably stop a mark from forming: the 63 to 90 percent of pregnancies that develop stretch marks includes plenty of women who moisturised every day, since genetics decide more of the outcome than any product on the surface. Checking a label against an ingredient decoder before buying anything new is a quick way to catch a hidden retinoid or a high percentage of an acid better left for later.

After the birth, what settles and what to book

For many women, melasma fades within a few months of delivery as hormone levels settle, though it can return in a later pregnancy or with hormonal contraception. Waiting those first months before booking a treatment usually means a smaller, more targeted job afterwards rather than a larger one started too early; see melasma, the pigmentation that rewards patience for what that plan looks like once the wait is over.

Stretch marks follow a similar clock: fresh marks stay pink or red for roughly the first 6 to 12 months, and that window, not day 1, is when a dermatologist can do the most for them with lasers or microneedling, as covered in stretch marks, red is treatable, white is hard.

Retinoids and any paused peel can usually resume once breastfeeding ends, and a postponed energy based procedure can be booked once a clinician confirms there is no reason left to wait, often a few weeks after an uncomplicated birth. Anything that looks urgent rather than cosmetic, a mole that is changing shape, a rash that will not settle, a lump that was not there before, skips this list entirely and goes to a doctor first, pregnant or not.

Questions to ask before any treatment during pregnancy

Frequently asked

Which skincare ingredients should I avoid during pregnancy?

All vitamin A derivatives, including retinol, retinaldehyde, tretinoin and adapalene, are avoided in pregnancy and while breastfeeding. High strength chemical peels and hydroquinone are paused too; azelaic acid and glycolic acid up to 10 percent are the common substitutes.

Why do I have new brown patches on my face?

This is melasma, sometimes called the mask of pregnancy, affecting 50 to 70 percent of pregnant women depending on the population studied. It is hormone driven and reacts strongly to UV and visible light, which is why daily sunscreen matters more than any cream.

Can oils prevent stretch marks?

Not reliably. Stretch marks appear in 63 to 90 percent of pregnancies, mostly during months 6 and 7, and while massage and oil keep skin supple, genetics decide more of the outcome than any product applied to the surface.

Are laser or radiofrequency treatments safe during pregnancy?

They are usually postponed because no controlled trials have tested them in pregnant women, not because harm has been proven. Most clinics reschedule elective energy based treatments for after delivery or after breastfeeding ends.

Will melasma go away after the baby is born?

For many women it fades within a few months of delivery as hormone levels settle, though it can return in a later pregnancy or with hormonal contraception. Waiting before treating it usually means less treatment is needed overall.

Is ordinary sunscreen enough?

A broad-spectrum mineral sunscreen of SPF 30 or higher, reapplied roughly every 2 hours outdoors, is the baseline. A tinted formula with iron oxide adds protection against the visible light that also triggers melasma.

Sources

• Putra IBD, Jusuf NK, Dewi NR. Skin changes and safety profile of topical products during pregnancy. The Journal of Clinical and Aesthetic Dermatology, 2022, 15(2) · melasma up to 70 percent, stretch marks 63 to 90 percent in months 6 to 7, telangiectasia 67 percent, nail changes 62.4 percent, glycolic acid up to 10 percent at pH above 3.5, azelaic acid 3 to 8 percent systemic absorption
• Topical Tretinoin, MotherToBaby fact sheet, Organization of Teratology Information Specialists · background birth defect rate about 3 in 100 pregnancies, topical tretinoin clears the body in about 1 day on average, recommendation to stop about 1 month before conception; updated July 2024
• Melasma patient information leaflet, British Association of Dermatologists · up to 50 percent of women affected in pregnancy, hydroquinone and retinoid creams avoided in pregnancy, SPF 30 or above with high UVA rating, can fade a few months after delivery

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This guide is for general information. It does not replace medical or professional cosmetic advice or an examination.